Organization
NORTH SHORE GASTROENTEROLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANENE WEILLS (CREDENTIALING & CONTRACTING COORD)
(440) 808-1212
Entity
Organization
Contact information
Practice address
850 COLUMBIA RD, SUITE 200, WESTLAKE, OH 44145-1493
(440) 808-1212
(440) 808-0321
Mailing address
850 COLUMBIA RD STE 200, WESTLAKE, OH 44145-7215
(440) 808-1212
(440) 808-0321
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
COA16300-NP
OHIO LICENSE
OH
Enumeration date
02/12/2015
Last updated
04/12/2018
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